What You Saw in Room 118 at 2 a.m.

Protect the resident first, then report - immediately.

1. Go into the room. Provide the care she needs yourself: check her, change her if soiled, settle her comfortably, and check the right forearm.
2. Do not leave her alone with that coworker. If you must step out, arrange for someone else to be present.
3. Report it now, not at 7 a.m. and not "after I think about it." Tell the charge nurse or RN on duty exactly what you heard and saw, in the words used. If the nurse is the person involved or dismisses it, go up the chain - nursing supervisor, director of nursing, administrator - and, if needed, the state hotline or long-term care ombudsman.
4. This is abuse, not a personality clash. The verbal threat and humiliation is verbal/emotional abuse; the hard, quick grab that made her cry out is physical abuse. Wisconsin's elder-adult-at-risk law requires any person - including a nurse aide - to report suspected abuse of an adult at risk, and facility policy will also require immediate notice to the administrator. Confused residents with dementia are the least able to report for themselves.
5. Tell the nurse about the bruise at the same time so a skin assessment can be done and documented.

Objective and time-stamped, with exact words:

• "At 2:10 a.m. heard staff member in room 118 state, 'Stop wetting the bed like a baby; I'm not changing you again.'"
• "At approximately 2:15 a.m., observed staff member grasp resident's right forearm and pull it quickly. Resident cried out and pulled away."
• "At 6:00 a.m., 4 cm purplish area noted on right forearm; not present on 11 p.m. shift two nights ago." Location, size, color - no diagnosis.
• What you did and who you told, with times and names.

What it does not look like:

• "The aide was abusive" or "I think she's been rough before" - conclusions belong to the investigation, not your note.
• Vague entries: "behavior problem," "incident in 118."
• Anything you did not personally see or hear.
• Charting after a delay without following late-entry policy, or going back and changing an earlier note.

Complete the facility incident report as directed. Do not discuss the details with other staff who do not need to know - that is both a confidentiality problem and a way to contaminate an investigation.

1. The resident cannot report it herself. Advanced dementia means she cannot tell anyone what happened, which is exactly why staff are the safety net. Silence makes her completely dependent on the conscience of the person harming her.

2. It will continue and escalate. Mistreatment that draws no response is reinforced. The bruise two nights in the making is evidence of a pattern, not a one-time lapse.

3. The law and your license. Nurse aides are mandatory reporters of suspected abuse of adults at risk under Wisconsin law, and failing to report can bring personal legal exposure and loss of your eligibility to work, regardless of what the facility does. "We're friends" is not a legal exception.

4. Retaliation against you is prohibited, and confidentiality cuts both ways. You are protected for reporting in good faith, and you are also required to keep the report confidential - telling other aides the story in the break room is gossip and a privacy breach, even when your motive feels right.

5. Your own integrity is part of the job. The resident's right to be free from abuse does not pause because reporting is uncomfortable. Report it, document it factually, and let the facility's process do its work.